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Biomedical subjects

J D Ward

Publications and source records attributed to J D Ward.

At least 73 records · Page 4Linked to original sources
PubMed1995

The cost of diabetic foot problems.

Diabetic foot problems are the commonest and most morbid complications of diabetes and constitute a major cost to any health care system. Foot problems result in the greatest number of admissions to hospital, and these become extremely costly. The demonstration in many areas of the health service that care, education, and the provision of good support to people results in fewer foot problems must be the spur for all those involved in diabetes care to improve services in all localities. Foot ulceration is much more common in deprived areas, and urgent research is required to determine exactly why this occurs so that appropriate remedies can be applied.

Diabetic Foot↗
PubMed1995

Differences in copper status and copper metabolism among Angus, Simmental, and Charolais cattle.

Thirty-eight pregnant Angus, Charolais, and Simmental heifers and their offspring were used to determine whether differences in Cu metabolism existed among breeds. The heifers were fed either 0 or 10 mg of supplemental Cu per kilogram of DM. Calves were born between d 70 and 125 of the 280 d experiment. There were few differences among breeds in plasma Cu concentration and ceruloplasmin activity when heifers were fed supplemental Cu. When heifers were not fed supplemental Cu, Angus heifers had greater (P < .10) plasma Cu concentrations than Simmental heifers from d 0 until 140 and Charolais heifers from d 28 until 140. Angus heifers had greater (P < .10) ceruloplasmin activity than Charolais and Simmental heifers between d 28 and 196. When dams were fed supplemental Cu, Angus calves had greater (P < .10) plasma Cu concentrations than Simmental calves on all days tested and Charolais calves on d 252 and 280. Ceruloplasmin activity of Angus calves in the Cu-supplemented group was greater (P < .10) than that of Charolais calves on d 224 and 280 and Simmental calves from d 224 until 280. Angus calves born to dams not receiving supplemental Cu had greater (P < .10) plasma Cu concentrations and ceruloplasmin activities than Simmental calves on all days tested. Angus calves also had greater (P < .10) plasma Cu concentrations than Charolais calves on d 196 and greater ceruloplasmin activities than Charolais calves from d 168 until 224. Eight Angus and eight Simmental steers were used to evaluate apparent Cu absorption and retention.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

Pediatric issues in head trauma.

Injuries are the leading cause of death in children, and brain injury is the most common cause of pediatric traumatic death. Numerous mechanisms of injury are unique to the child, including walker injuries, skateboard injuries, falls, and child abuse, as well as those injuries common to all age groups. Motor vehicle accidents account for the largest number of severe injuries in children. The cerebrovascular response of the child is different from the adult's in severe head injury. The patient's resting cerebral blood flow is higher. There seems to be a higher incidence of cerebral swelling, although not as frequent as previously thought. Special attention should focus on the small systemic blood volume, temperature instability, and difficulty in intubating small children. Intracranial pressure (ICP) monitoring should be performed in patients with severe head injuries. The occurrence of increased ICP in severe head injury may be as high as 60% during the patient's course. Child abuse, as well as the "shaken baby" syndrome, is a particular problem that should be recognized and appropriately handled. The outcome should be carefully assessed in the young patient. While the injury may be the cause of a patient's abnormal development, other factors should also be considered.

Adolescent↗
PubMed1995

Biochemical and vascular factors in the pathogenesis of diabetic neuropathy.

The reasons humans develop diabetic neuropathy are not known. It seems likely that, as in animals, the polyol-myoinositol-aldose reductase controlled pathways are relevant at an early stage and are related to hyperglycemia. Perhaps these metabolic factors influence the structural and dynamic aspects of the microvasculature which are so clearly abnormal in established diabetic neuropathy. A demonstration that these metabolic factors in some way affect the vasculature would be important, for that would allow some logic in administering inhibitors to prevent vessel changes of such a pathological nature. At the moment, the case for the long-term administration of aldose reductase inhibitors to prevent nerve damage is not proven, and the decision to administer them will cause some difficulty to physicians. Unfortunately, the situation is more complex than this simple aldose reductase-microvascular hypothesis, for consideration must be given to the known glycation of nerve proteins, the involvement of fatty acid metabolism within the vasculature, and the undoubted role of growth factors.

Aldehyde Reductase↗
PubMed1994

Transperineurial capillary abnormalities in the sural nerve of patients with diabetic neuropathy.

Morphometric techniques were employed to assess perineurial capillary abnormalities in the sural nerve of 20 diabetic patients with neuropathy and 10 normal control subjects. Structural abnormalities were related to quantitative neurophysiological and neuropathological measures of neuropathy. Perineurial capillary endothelial cell area (P < 0.001) and endothelial cell profile number (P < 0.01) were increased and luminal area (P < 0.001) was reduced in diabetic patients when compared with control subjects. A significant relationship was observed between endothelial cell hyperplasia and measures of neuropathic severity. These findings provide evidence for perineurial capillary luminal occlusion due primarily to both endothelial cell hypertrophy and hyperplasia. Such a reduction in luminal size is expected to reduce transperineurial and hence endoneurial blood flow, resulting in endoneurial hypoxia and hence human diabetic neuropathy.

Adult↗
PubMed1994

Vascular factors in diabetic neuropathy.

Despite considerable research we still do not have a comprehensive explanation for the pathogenesis of diabetic neuropathy. Although chronic hyperglycaemia is almost certainly involved, it is not known whether the primary pathology is metabolic, microvascular, or an interaction between the two. Hyperglycaemia-induced polyol pathway hyperactivity associated with nerve sorbitol accumulation and myo-inositol depletion may play a part in the genesis of diabetic neuropathy. The case for microvascular disease in diabetic neuropathy is now strong. Fibre loss in human sural nerve is multifocal, suggesting ischaemia. The degree of vessel disease has been related to the severity of neuropathy. People with chronic obstructive pulmonary disease develop the so called "hypoxic neuropathy" in which similar microvascular changes occur as in diabetic neuropathy. In rats with experimental diabetic neuropathy nerve blood flow is reduced and oxygen supplementation or vasodilator treatment improved the deterioration in conduction velocity and nerve blood flow. Similarly, in human diabetic neuropathy, there is impaired nerve blood flow, epineurial arterio-venous shunting and a reduction in sural nerve oxygen tension. At what stage during the development of nerve damage these changes occur is yet to be determined.

Animals↗
PubMed1994

Comparative analysis of the genetic associations of HLA-DR3 and tumour necrosis factor alpha with human IDDM.

Insulin-dependent diabetes mellitus (IDDM) is associated with class II molecules of the MHC on chromosome 6, in particular HLA-DR and -DQ alleles, but a pathogenic role for TNF-alpha in the class III region of the MHC has also been implied. We therefore tested whether there was any independent association between a biallelic TNF polymorphism and IDDM. The TNF2 allele was present in 61 of 114 (54%) IDDM patients compared to 101 of 253 (40%) control subjects (odds ratio 1.73; p < 0.02). Stratification analysis in individuals matched for HLA-DR3 revealed, however, that this association was not independent of HLA-DR3 and is most likely to be a result of linkage disequilibrium between these alleles.

Adult↗
PubMed1994

Penetrating head injury.

Penetrating head injuries are a significant public health problem in the United States, with an estimated 33,000 gun-related deaths and many more nonfatal shootings per year. Initial treatment for a penetrating head injury is similar to that of a closed head injury. That is, all efforts must be made to prevent any secondary insults, hypoxia, or ischemia. This translates into the standard methodology of care of the trauma patient. The basic neurologic examination consists of using the Glasgow Coma Score and estimation of pupillary function and some estimation of brain stem function and motor power. The radiologic test of choice for a penetrating head injury is the computed tomography scan. There are several indications for surgery: the patient's condition will be improved or significant neurologic sequelae will be averted; the patient is sufficiently stabilized from any other injuries such that he or she can tolerate surgery; the condition of the patient is not so poor that surgery will have no effect; and the area of penetration is reasonably accessible to surgical intervention. Three main goals of medical management of a penetrating head injury include (1) control of hypertension, (2) maintenance of adequate cerebral circulation oxygenation, and (3) prevention of secondary complications. Outcome after a penetrating head injury is related to the extent of brain tissue damage caused either directly or indirectly by the missile as well as any indirect insults. The most significant indicator, particularly in terms of survival versus death, has consistently been the patient's presenting neurologic status. Some investigators have recommended that a patient presenting with a Glasgow Coma Scale Score of > 5 should not be treated. Others have said that patients with a low coma score and transventricular gunshot wounds should not be treated because of the high mortality. If the patient survives a penetrating head injury, he or she generally goes on to experience a relatively good functional outcome. Only if all components of a good treatment regimen are in place will patients and their families obtain the best possible outcome.

Craniocerebral Trauma↗
PubMed1994

Hospital admissions and social deprivation of patients with diabetes mellitus.

This study examined the relationship between hospital admissions for patients with diabetes mellitus and residence in an area of social deprivation. Admissions of patients with diabetes mellitus were identified during a 5-year period between 1987 and 1992 using the district patient information service. All persons admitted were assigned to an electoral ward on the basis of their postcode. Age standardized admission rates were compared to the Townsend Deprivation Score for each electoral ward. A positive correlation was found between age standardized admission rate and Townsend Score (r = 0.76, p < 0.001). We believe this has significance for planning health care resources.

Diabetes Mellitus↗
PubMed1994

The prevalence of foot ulceration and its correlates in type 2 diabetic patients: a population-based study.

The prevalence of peripheral neuropathy, peripheral vascular disease, and foot ulceration in Type 2 diabetic patients in the community were determined in a community-based study. Eight hundred and eleven subjects (404 male, 407 female, mean age 65.4 (range 34-90) years, diabetes duration 7.4 (0-50) years) from 37 general practices in three UK cities were studied. Neuropathy was diagnosed clinically using modified neuropathy disability scores which were ascertained using structured interviews and clinical examinations by one observer in each city. Peripheral vascular disease was diagnosed if a history of revascularization was present or > or = 2 foot pulses were absent. History of current or previous foot ulceration was recorded. The prevalence of neuropathy was 41.6% (95% confidence limits 38.3-44.9%) and the prevalence of PVD, 11% (9.1-13.7%). Forty-eight percent of neuropathic patients reported significant neuropathic symptoms. Forty-three patients (5.3% (3.8-6.8%)) had current or past foot ulcers; 20 of these were pure neuropathic ulcers, 13 neuroischaemic, 5 pure vascular, and 5 were unclassified. Multiple logistic regression showed history of amputation, neuropathy disability score, and peripheral vascular disease to be significantly associated with foot ulceration after adjusting for age and diabetes duration. A substantial proportion of Type 2 diabetic patients, often elderly patients who do not attend hospitals, suffered from peripheral neuropathy and peripheral vascular disease. These patients are at risk of foot ulceration and may benefit from preventive footcare.

Adult↗
PubMed1994

Pediatric head injury: a further experience.

This report consists of 201 patients seen at the Medical College of Virginia from May 1976 to October 1991. They are divided into two groups. The first group is from May 1976 to June 1984 and the second group is from July 1984 to October 1991. The two groups are compared as regards age, Glasgow coma score (GCS), presence of surgical mass lesion, mechanism of injury, intracranial pressure (ICP) course, and outcome. There was a significant difference in the initial GCS between the first and second group with the second group having a lower GCS. In addition, an analysis of the ICP course in group II showed a much lower incidence (5%) of a normal ICP course. There was no difference in outcome between the two groups. The results in the 201 patients are compared to other series.

Adolescent↗
PubMed1994

Atlantooccipital subluxation in a neonate with Down's syndrome. Case report and review of the literature.

Atlantooccipital subluxation (AOS) occurs in up to 63% of patients with Down's syndrome. However, presenting symptoms and the age at which preoperative screening becomes necessary have not been clearly delineated. Recently, a 16-day-old female with Down's syndrome and AOS presented to our institution. Following patent ductus arteriosus ligation, her neurological examination revealed trace movement, few spontaneous respirations, and left lower extremity clonus. Cervical spine radiographs revealed significant AOS. She was reduced and underwent a fusion from the occiput to C2. She gradually regained full strength and sensation. This case is the youngest example of AOS related to Down's syndrome described. It emphasizes the need for preoperative screening of all patients with Down's syndrome.

Atlanto-Occipital Joint↗
PubMed1994

Effect of dietary copper, iron, and molybdenum on growth and copper status of beef cows and calves.

A study was conducted to determine the effects of copper (Cu) depletion by feeding diets high in either iron (Fe) or molybdenum (Mo) on performance and Cu status of beef cows and calves. Thirty-eight 2-yr-old beef heifers, entering the last one-third of gestation, were randomly assigned by expected calving date to one of four diets: 1) control (CON; corn silage-soybean meal-based diet, 4 mg of Cu/kg), 2) control + 600 mg of Fe (as FeCO3)/kg, 3) control + 5 mg of Mo (as Na2MoO4)/kg, and 4) control + 10 mg of Cu (as CuSO4)/kg. From d 28 until after the end of the calving season (d 125), heifers receiving supplemental Cu had higher (P < .05) plasma Cu levels and ceruloplasmin activities than heifers fed the other diets. By d 224, plasma Cu concentrations of heifers fed the CON and Fe diets had increased to levels similar to those observed in the Cu-supplemented heifers, whereas the Mo heifers exhibited the lowest (P < .05) plasma Cu of the four treatments from d 168 through the remainder of the 280-d trial. Plasma Cu concentrations and ceruloplasmin activities were greater (P < .05) in Cu-supplemented than in non-Cu-supplemented calves (diets 1, 2, and 3) from d 168 onward, and the Fe- and Mo-supplemented calves did not differ in either measurement at any time during the trial. Rate of gain did not differ among calves fed the CON, Fe- or Cu-supplemented diets, whereas the Mo-supplemented calves gained at a much slower (P < .05) rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Animal Feed↗
PubMed1993

Traumatic brain tissue acidosis: experimental and clinical studies.

We have been focusing on potential metabolic derangement associated with severe head injury and a clinical trail directed toward treating brain tissue acidosis is currently underway. More specifically, we based this study on the hypothesis that following brain trauma brain tissue acidosis develops which may contribute to the prolongation of coma and neurologic deficit. Tromethamine (THAM), a safe and low toxicity agent which buffers in major part by causing a hypocapnic alkalosis, was selected for trial. Patients admitted with GCS < 8 were randomized into one of three arms: control: THAM plus hyperventilation; hyperventilation alone. Each regimen was maintained for 5 days post injury. Our analysis of 3 and 6 months Glasgow outcome score showed that prophylactic hyperventilation retards recovery, and the use of THAM overcomes the apparent deleterious effects of hyperventilation. One explanation is that the reduced ICP instability observed in THAM treated patients may account for this improvement. Is THAM effective in buffering traumatized brain tissue? What factors account for improvement in ICP stability? We addressed these questions in experimental studies utilizing MR spectroscopy to measure brain lactate production and tissue pH in fluid percussed anaesthetized cats. The protocol was designed to match our clinical trial, and brain injured animals were randomized into control, THAM, and hyperventilated groups. We observed that brain lactate production increased with trauma and remained above control at 8 hrs post injury. Lactate production in THAM treated animals was not elevated. Highest lactate production was associated with injured animals treated with sustained hyperventilation.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid-Base Equilibrium↗
PubMed1993

Impaired blood flow and arterio-venous shunting in human diabetic neuropathy: a novel technique of nerve photography and fluorescein angiography.

New techniques of sural nerve photography and fluorescein angiography which are able to provide an index of nerve blood flow have been developed. Under local anaesthetic, 3 cm of sural nerve was exposed at the ankle using an operating microscope. Without disturbing the epineurium, vessels were identified and photographed at a standard magnification (x 30). These were independently graded by an ophthalmologist not otherwise involved with the study. Fluorescein angiography was then carried out on the exposed nerve. The fluorescein appearance time and intensity of fluorescence were quantified, using computer analysis of digitised images. Thirteen subjects with chronic sensory motor neuropathy, five non-neuropathic diabetic and nine normal control subjects were studied. The mean epineurial vessel pathology score of the neuropathic group was significantly higher than the combined normal control and non-neuropathic diabetic groups (p < 0.01). Direct epineurial arteriovenous shunting was observed in six neuropathic and one non-neuropathic diabetic patients and not in any of the normal control subjects. The nerve fluorescein appearance time was significantly delayed in subjects with chronic sensory motor neuropathy (51.5 +/- 12 s) compared to both normal (34.7 +/- 9 s, p < 0.01) and non-neuropathic diabetic subjects (33.4 +/- 11 s, p < 0.025). The mean intensity of fluorescence at 96, 252 and 576 s, was significantly lower in subjects with chronic sensory motor neuropathy compared with both of the other groups (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Arteries↗
PubMed1993

Endoneurial localisation of microvascular damage in human diabetic neuropathy.

Twenty diabetic patients with neuropathy underwent clinical and neurophysiological evaluation together with a detailed morphometric assessment of capillary pathology in endoneurial and epineurial microvascular beds of the sural nerve. Morphological data were compared with ten non-diabetic control subjects. There were no significant differences in control subjects between basement membrane area, endothelial cell area, endothelial cell profile number or luminal area of endoneurial when compared with epineurial capillaries. In contrast, when compared with epineurial capillaries, endoneurial capillaries from diabetic patients demonstrated a significant increase in basement membrane (p < 0.001) and endothelial cell (p < 0.001) area and a significant reduction in luminal area (p < 0.001). There was no significant difference in endothelial cell profile number between endoneurial and epineurial capillaries amongst diabetic patients. Previous studies have demonstrated a good correlation between the degree of microangiopathy and measures of neuropathic severity. In the present study increased endoneurial capillary basement membrane area was significantly related to reduced peroneal nerve conduction velocity (p < 0.001), myelinated fibre density (p < 0.001) and elevated vibration (p < 0.05) and thermal (p < 0.001) perception. Increased endothelial cell area and reduced luminal size were related to a reduced peroneal nerve conduction (p < 0.05, p < 0.01, respectively), reduced myelinated fibre density (p < 0.05, p < 0.01) and elevated thermal perception (p < 0.05, p < 0.001). Epineurial capillary basement membrane, endothelial cell and luminal area failed to relate to measures of neuropathic severity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗